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Kidney stones

Renal calculi; Nephrolithiasis; Stones - kidney; Calcium oxalate - stones; Cystine - stones; Struvite - stones; Uric acid - stones; Urinary lithiasis

 

A kidney stone is a solid mass made up of tiny crystals. One or more stones can be in the kidney or ureter at the same time.

Causes

 

Kidney stones are common. Some types run in families. They often occur in premature infants.

There are different types of kidney stones. The cause of the problem depends on the type of stone.

Stones can form when urine contains too much of certain substances that form crystals. These crystals can develop into stones over weeks or months.

  • Calcium stones are most common. They are most likely to occur in men between ages 20 to 30. Calcium can combine with other substances to form the stone.
  • Oxalate is the most common of these. Oxalate is present in certain foods such as spinach. It is also found in vitamin C supplements. Diseases of the small intestine increase your risk of these stones.

Calcium stones can also form from combining with phosphate or carbonate.

Other types of stones include:

  • Cystine stones can form in people who have cystinuria. This disorder runs in families. It affects both men and women.
  • Struvite stones are mostly found in women who have a urinary tract infection. These stones can grow very large and can block the kidney, ureter, or bladder.
  • Uric acid stones are more common in men than in women. They can occur with gout or chemotherapy.
  • Other substances such as certain medicines also can form stones.

The biggest risk factor for kidney stones is not drinking enough fluids. Kidney stones are more likely to occur if you make less than 1 liter (32 ounces) of urine a day.

 

Symptoms

 

You may not have symptoms until the stones move down the tubes (ureters) through which urine empties into your bladder. When this happens, the stones can block the flow of urine out of the kidneys.

The main symptom is severe pain that starts and stops suddenly:

  • Pain may be felt in the belly area or side of the back.
  • Pain may move to groin area (groin pain) or testicles (testicle pain).

Other symptoms can include:

  • Abnormal urine color
  • Blood in the urine
  • Chills
  • Fever
  • Nausea and vomiting

 

Exams and Tests

 

The health care provider will perform a physical exam. The belly area (abdomen) or back might feel sore.

Tests that may be done include:

  • Blood tests to check calcium, phosphorus, uric acid, and electrolyte levels
  • Kidney function tests
  • Urinalysis to see crystals and look for red blood cells in urine
  • Examination of the stone to determine the type

Stones or a blockage can be seen on:

  • Abdominal CT scan
  • Abdominal/kidney MRI
  • Abdominal x-rays
  • Intravenous pyelogram (IVP)
  • Kidney ultrasound
  • Retrograde pyelogram

 

Treatment

 

Treatment depends on the type of stone and the severity of your symptoms.

Kidney stones that are small most often pass through your system on their own.

  • Your urine should be strained so the stone can be saved and tested.
  • Drink at least 6 to 8 glasses of water per day to produce a large amount of urine. This will help the stone pass.
  • Pain can be very bad. Over-the-counter pain medicines (for example, ibuprofen and naproxen), either alone or along with narcotics, can be very effective.

Some people with severe pain from kidney stones need to stay in the hospital. You may need to get fluids through a vein.

For some types of stones, your provider may prescribe medicine to prevent stones from forming or help break down and remove the material that is causing the stone. These medicines can include:

  • Allopurinol (for uric acid stones)
  • Antibiotics (for struvite stones)
  • Diuretics (water pills)
  • Phosphate solutions
  • Sodium bicarbonate or sodium citrate
  • Water pills (thiazide diuretics)
  • Tamsulosin to relax the ureter and help the stone pass

Surgery is often needed if:

  • The stone is too large to pass on its own
  • The stone is growing
  • The stone is blocking urine flow and causing an infection or kidney damage
  • The pain cannot be controlled

Today, most treatments are much less invasive than in the past.

  • Lithotripsy is used to remove stones slightly smaller than a half an inch (1.25 centimeters) that are located in the kidney or ureter. It uses sound or shock waves to break up stones. Then, the stone fragments leave the body in the urine. It is also called extracorporeal shock-wave lithotripsy or ESWL.
  • Procedures performed by passing a special instrument through a small surgical cut in your skin and into your kidney or ureters are used for large stones, or when the kidneys or surrounding areas are incorrectly formed. The stone is removed with a tube (endoscope).
  • Ureteroscopy may be used for stones in the lower urinary tract.
  • Rarely, open surgery (nephrolithotomy) may be needed if other methods do not work or are not possible.

Talk to your provider about what treatment options may work for you.

You will need to take self-care steps. Which steps you take depend on the type of stone you have, but they may include:

  • Drinking extra water and other liquids
  • Eating more of some foods and cutting back on other foods
  • Taking medicines to help prevent stones
  • Taking medicines to help you pass a stone (anti-inflammatory drugs, alpha-blockers)

 

Outlook (Prognosis)

 

Kidney stones are painful but most of the time can be removed from the body without causing lasting damage.

Kidney stones often come back. This occurs more often if the cause is not found and treated.

You are at risk for:

  • Urinary tract infection
  • Kidney damage or scarring if treatment is delayed for too long

 

Possible Complications

 

Complication of kidney stones may include the obstruction of the ureter (acute unilateral obstructive uropathy).

 

When to Contact a Medical Professional

 

Call your provider if you have symptoms of a kidney stone:

  • Severe pain in your back or side that will not go away
  • Blood in your urine
  • Fever and chills
  • Vomiting
  • Urine that smells bad or looks cloudy
  • A burning feeling when you urinate

If you have been diagnosed with blockage from a stone, passage must be confirmed either by capture in a strainer during urination or by follow-up x-ray.

 

Prevention

 

If you have a history of stones:

  • Drink plenty of fluids (6 to 8 glasses of water per day) to produce enough urine.
  • You may need to take medicine or make changes to your diet for some types of stones.
  • Your provider may want to do blood and urine tests to help determine the proper prevention steps.

 

 

References

Bushinsky DA. Nephrolithiasis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 126.

Fink HA, Wilt TJ, Eidman KE, et al. Medical management to prevent recurrent nephrolithiasis in adults: a systematic review for an American College of Physicians Clinical Guideline. Ann Intern Med. 2013;158(7):535-543. PMID: 23546565 www.ncbi.nlm.nih.gov/pubmed/23546565.

Fink HA, Wilt TJ, Eidman KE, et al. Recurrent nephrolithiasis in adults: comparative effectiveness of preventive medical strategies [Internet]. Rockville, MD. Agency for Healthcare Research and Quality (US) 2012; Report No.: 12-EHC049-EF. PMID: 22896859 www.ncbi.nlm.nih.gov/pubmed/22896859.

Lipkin ME, Ferrandino MN, Preminger Glenn M. Evaluation and medical management of urinary lithiasis. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 52.

Qaseem A, Dallas P, Forciea MA, Starkey M, Denberg TD; Clinical Guidelines Committee of the American College of Physicians. Dietary and pharmacologic management to prevent recurrent nephrolithiasis in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161(9):659-667. PMID: 25364887 www.ncbi.nlm.nih.gov/pubmed/25364887.

 
  • Kidney stones

    Kidney stones

    Animation

  •  

    Kidney stones - Animation

    This animation begins with an front view of the urinary tract and continues with the formation of kidney stones shown in a cut-section of the kidney. Severities of kidney stones are depicted, demonstrating various degrees of urine obstruction.

  • Kidney stones

    Kidney stones

    Animation

  •  

    Kidney stones - Animation

    If you ever have severe pain in your belly or one side of your back that comes and goes suddenly, you may be passing a kidney stone. Let's talk about the painful condition of kidney stones. A kidney stone is a mass of tiny crystals in your kidney or urinary tract. Stones are quite common, and tend to run in families. They can form in weeks or months when your urine contains too much of certain substances. There are several kinds of kidney stones. Calcium stones are by far the most common kind. They often form in men between the ages of 20 to 30. Calcium can combine with other substances found in your food, like oxalate, phosphate, or carbonate, to form stones. Cystine stones can form in people who have cystinuria, a condition passed down through families in which stones are made from an amino acid called cystine. Struvite stones are found mostly in women who have urinary tract infections. These stones can grow very large and can block the kidney, ureter, or bladder. Uric acid stones are more common in men than in women. They can occur in people who have a history of gout or are going through chemotherapy. So, how do you know if you have kidney stones? Well, you may not have symptoms until the stone move down the ureter tubes through which urine empties into your bladder. When this happens, the stones can block the flow of urine out of your kidneys. The main symptom is severe sharp pain that starts suddenly, usually in your belly or one side of your back, and it may go away just as quickly. Other symptoms can include abnormal urine color, blood in your urine, fever, chills, nausea, and vomiting. So, what do you do about kidney stones? Well, your health care provider will perform a physical exam. You may need blood tests, kidney function tests, and tests that look for crystals in your urine. Several imaging tests, like a CT scan, can see stones or a blockage in your urinary tract. Treatment will depend on the type of stone you have, and how bad your symptoms are. Small kidney stones that are less than 5 mm in diameter will usually pass on their own. You should drink at least 6 to 8 glasses of water per day to produce a large enough amount of urine to help bring the stone out. Pain can be pretty bad when you pass a kidney stone, so your doctor may prescribe pain medicines to help as well as medications that will help the stone pass. Other medicines can decrease stone formation or help break down and remove the material that is causing you to make stones. You may need surgery if the stone is too large to pass, the stone is growing, or the stone is blocking your urine flow. Kidney stones are painful, but you can usually pass them without causing permanent harm. However, kidney stones often come back, so you and your doctor will need to work on finding the cause of your stone. Lastly, delaying treatment can lead to serious complications, so if you think that you have kidney stones see your doctor right away.

  • Kidney anatomy

    Kidney anatomy - illustration

    The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and stimulating red blood cell production.

    Kidney anatomy

    illustration

  • Kidney - blood and urine flow

    Kidney - blood and urine flow - illustration

    This is the typical appearance of the blood vessels (vasculature) and urine flow pattern in the kidney. The blood vessels are shown in red and the urine flow pattern in yellow.

    Kidney - blood and urine flow

    illustration

  • Nephrolithiasis

    Nephrolithiasis - illustration

    Kidney stones result when urine becomes too concentrated and substances in the urine crystalize to form stones. Symptoms arise when the stones begin to move down the ureter causing intense pain. Kidney stones may form in the pelvis or calyces of the kidney or in the ureter.

    Nephrolithiasis

    illustration

  • Intravenous pyelogram (IVP)

    Intravenous pyelogram (IVP) - illustration

    In the procedure intravenous pyelogram (IVP), the patient is injected with radiopaque dye and X-rays are taken as the dye travels through the urinary tract. This procedure is performed to confirm the presence of kidney stones, although some stones may be too small to see.

    Intravenous pyelogram (IVP)

    illustration

  • Lithotripsy procedure

    Lithotripsy procedure - illustration

    Extracorporeal shock wave lithotripsy (ESWL) is a procedure used to shatter simple stones in the kidney or upper urinary tract. Ultrasonic waves are passed through the body until they strike the dense stones. Pulses of sonic waves pulverize the stones, which are then more easily passed through the ureter and out of the body in the urine.

    Lithotripsy procedure

    illustration

  • Kidney stones

    Animation

  •  

    Kidney stones - Animation

    This animation begins with an front view of the urinary tract and continues with the formation of kidney stones shown in a cut-section of the kidney. Severities of kidney stones are depicted, demonstrating various degrees of urine obstruction.

  • Kidney stones

    Animation

  •  

    Kidney stones - Animation

    If you ever have severe pain in your belly or one side of your back that comes and goes suddenly, you may be passing a kidney stone. Let's talk about the painful condition of kidney stones. A kidney stone is a mass of tiny crystals in your kidney or urinary tract. Stones are quite common, and tend to run in families. They can form in weeks or months when your urine contains too much of certain substances. There are several kinds of kidney stones. Calcium stones are by far the most common kind. They often form in men between the ages of 20 to 30. Calcium can combine with other substances found in your food, like oxalate, phosphate, or carbonate, to form stones. Cystine stones can form in people who have cystinuria, a condition passed down through families in which stones are made from an amino acid called cystine. Struvite stones are found mostly in women who have urinary tract infections. These stones can grow very large and can block the kidney, ureter, or bladder. Uric acid stones are more common in men than in women. They can occur in people who have a history of gout or are going through chemotherapy. So, how do you know if you have kidney stones? Well, you may not have symptoms until the stone move down the ureter tubes through which urine empties into your bladder. When this happens, the stones can block the flow of urine out of your kidneys. The main symptom is severe sharp pain that starts suddenly, usually in your belly or one side of your back, and it may go away just as quickly. Other symptoms can include abnormal urine color, blood in your urine, fever, chills, nausea, and vomiting. So, what do you do about kidney stones? Well, your health care provider will perform a physical exam. You may need blood tests, kidney function tests, and tests that look for crystals in your urine. Several imaging tests, like a CT scan, can see stones or a blockage in your urinary tract. Treatment will depend on the type of stone you have, and how bad your symptoms are. Small kidney stones that are less than 5 mm in diameter will usually pass on their own. You should drink at least 6 to 8 glasses of water per day to produce a large enough amount of urine to help bring the stone out. Pain can be pretty bad when you pass a kidney stone, so your doctor may prescribe pain medicines to help as well as medications that will help the stone pass. Other medicines can decrease stone formation or help break down and remove the material that is causing you to make stones. You may need surgery if the stone is too large to pass, the stone is growing, or the stone is blocking your urine flow. Kidney stones are painful, but you can usually pass them without causing permanent harm. However, kidney stones often come back, so you and your doctor will need to work on finding the cause of your stone. Lastly, delaying treatment can lead to serious complications, so if you think that you have kidney stones see your doctor right away.

  • Kidney anatomy

    Kidney anatomy - illustration

    The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and stimulating red blood cell production.

    Kidney anatomy

    illustration

  • Kidney - blood and urine flow

    Kidney - blood and urine flow - illustration

    This is the typical appearance of the blood vessels (vasculature) and urine flow pattern in the kidney. The blood vessels are shown in red and the urine flow pattern in yellow.

    Kidney - blood and urine flow

    illustration

  • Nephrolithiasis

    Nephrolithiasis - illustration

    Kidney stones result when urine becomes too concentrated and substances in the urine crystalize to form stones. Symptoms arise when the stones begin to move down the ureter causing intense pain. Kidney stones may form in the pelvis or calyces of the kidney or in the ureter.

    Nephrolithiasis

    illustration

  • Intravenous pyelogram (IVP)

    Intravenous pyelogram (IVP) - illustration

    In the procedure intravenous pyelogram (IVP), the patient is injected with radiopaque dye and X-rays are taken as the dye travels through the urinary tract. This procedure is performed to confirm the presence of kidney stones, although some stones may be too small to see.

    Intravenous pyelogram (IVP)

    illustration

  • Lithotripsy procedure

    Lithotripsy procedure - illustration

    Extracorporeal shock wave lithotripsy (ESWL) is a procedure used to shatter simple stones in the kidney or upper urinary tract. Ultrasonic waves are passed through the body until they strike the dense stones. Pulses of sonic waves pulverize the stones, which are then more easily passed through the ureter and out of the body in the urine.

    Lithotripsy procedure

    illustration

A Closer Look

 

Talking to your MD

 

Self Care

 

Tests for Kidney stones

 

     

    Review Date: 8/31/2015

    Reviewed By: Jennifer Sobol, DO, urologist at the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Internal review and update on 09/01/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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